Department of Neurology, Atrium Medical Centre Parkstad, PO Box 4446, 6401 CX, Heerlen, The Netherlands,
J Neurol. 2013 Oct;260(10):2596-605. doi: 10.1007/s00415-013-7024-x. Epub 2013 Jul 14.
Response to 100 % oxygen as acute treatment for cluster headache is relative low considering certain subgroups or predictors. The primary purpose of the present study was to find prospectively which factors differ between responders and non-responders to oxygen therapy. The second goal was to find whether any of these differences would clarify the mechanism of pain reduction by oxygen and cluster headache pathophysiology. Patients diagnosed with cluster headache according to the ICHD-II criteria, who started on oxygen therapy (n = 193), were recruited from 51 outpatient clinics and via patient websites in The Netherlands. Patients had to return two questionnaires around the start of oxygen therapy (n = 120). Eventually, 94 patients were included. Clear non- plus moderate responders had ever used pizotifen more often (p = 0.03). Clear non-responders more often had photophobia or phonophobia during cluster headache attacks (p = 0.047) and more often had used triptans in the same active phase as the phase in which they had used oxygen for the first time (p = 0.02). Using correction for multiple testing, we could only confirm a statistically significant difference in triptan use. We were unable to locate the level of action of oxygen in the thalamus and cortex or confirm the sites of its action presently known, solely based on current knowledge of photophobia circuits. However, we conclude that particularly the higher frequency of photophobia or phonophobia in clear non-responders deserves further study to understand the mechanism of pain reduction by oxygen and cluster headache pathophysiology.
考虑到某些亚组或预测因素，对丛集性头痛患者使用 100%氧气进行急性治疗的反应相对较低。本研究的主要目的是前瞻性地找出对氧疗有反应和无反应的患者之间存在哪些差异。第二个目标是确定这些差异中是否有任何差异可以阐明氧气减轻疼痛的机制和丛集性头痛的病理生理学。根据 ICHD-II 标准诊断为丛集性头痛的患者，在荷兰的 51 个门诊诊所和患者网站招募，开始接受氧疗（n = 193）。患者必须在开始氧疗时（n = 120）返回两份问卷。最终，94 名患者被纳入研究。明确的无反应者和中度反应者曾经更频繁地使用哌替啶（p = 0.03）。明确的无反应者在丛集性头痛发作期间更经常出现畏光或恐声（p = 0.047），并且更经常在使用氧气的同一活跃期内也使用了曲坦类药物（p = 0.02）。在进行多次测试校正后，我们只能确认曲坦类药物使用的统计学差异。我们无法根据当前对畏光回路的了解，确定丘脑和皮质中氧气的作用水平，或确认其目前已知的作用部位。然而，我们得出的结论是，特别是在明确的无反应者中，更频繁出现的畏光或恐声现象值得进一步研究，以了解氧气减轻疼痛的机制和丛集性头痛的病理生理学。
